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U-M School of Dentistry, Others Pioneer New Approach to Dental Care

Ann Arbor, MI — June 29, 2015 — It’s the first reported case of a dental “replacement part” being created in a laboratory using bioengineering and three-dimensional printing to help an adult human patient alleviate the effects of periodontal disease.

Dr. William Giannobile, chair of the Department of Periodontics and Oral Medicine at the University of Michigan School of Dentistry, collaborated with colleagues at U-M and the University of Milan, Italy, to develop a customized dental scaffold that was placed in the patient’s mouth to stimulate regeneration of periodontal tissues.

“Several factors converged that enabled us to proceed on this first human case using 3D printing to treat the patient,” Giannobile said.

Those factors began to come together in 2011 when Dr. Giulio Rasperini, a professor of dentistry at the University of Milan, was in Ann Arbor as the Ramfjord Visiting Professor, to learn more about some of the pioneering work being done in Giannobile’s lab.

Rasperini, who has worked extensively with Giannobile for more than 10 years, is lead author of the case report, “3D-Printed Bioresorbable Scaffold for Periodontal Repair.” The paper appears today in “Online First,” the electronic version of the July issue of the Journal of Dental Research. The case report is scheduled to appear in print in the September issue of JDR.

Two years ago, a 53-year-old male approached Rasperini seeking treatment for aggressive bone destruction around a lower canine tooth that compromised the tooth’s supporting structures. Having collaborated extensively previously, both Rasperini and Giannobile discussed the possibility of fabricating a scaffold that would be placed in the patient’s mouth to help alleviate what Rasperini characterized as the patient’s “hopeless prognosis.”

Patient Consents to Novel Procedure

“We were concerned because this was the first time a scaffold would be fabricated using bioengineering as well as three-dimensional printing, which is relatively new in dentistry and periodontics,” Giannobile said.

“We told the patient about the risks involved, notably that using a combination of bioengineering and 3D printing had never been used to help ease a problem in the mouth of an adult before,” he said. “We told the patient there was a significant chance of infection since the area around the tooth would be exposed to an external substance.” Informed of potential risks, the patient agreed to the procedure.

Following a CT scan in Rasperini’s Milan office, the dimensions of the scaffold were sent electronically to Giannobile’s lab at the School of Dentistry. Giannobile collaborated with Dr. Scott Hollister, a professor of biomedical engineering at the U-M College of Engineering and a pioneer in the use of 3D printing for medical applications, about the scaffold. A PhD student in Giannobile’s laboratory, Sophia Pilipchuk, manufactured the scaffold with a 3D printer. Pilipchuk is a student in the Department of Biomedical Engineering at the College of Engineering. In an interview with Dr. Dana Graves, associate editor of JDR, Hollister describes how 3D printing is advancing health care:

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Since there are several types of tissue in the mouth, Giannobile said a major challenge was customizing the scaffold to the complex topography of the patient’s periodontal wound. A slowly resorbing plastic material, polycaprolactone (PCL), and another substance, hydroxyapatite, were used to make the 3D scaffold. Hydroxyapatite is a naturally derived mineral-based material that is a structural building block of teeth and bones. The scaffold was combined with a platelet-derived growth factor that has been approved by the U.S. Food and Drug Administration to stimulate periodontal regeneration.

After the scaffold was made in Ann Arbor, it was delivered to Italy where the University of Milan Institutional Review Board approved placing the scaffold in the patient’s mouth.

Results

Rasperini performed the surgery and Giannobile assisted with the delivery of the scaffold. “The procedure succeeded in the short term. We were able to help the patient for 13 months,” Giannobile said. The scaffold, however, eventually became exposed and had to be removed. After removal, the scaffold was examined microscopically, along with the bone in the patient’s mouth.

“This was an important small step to better understand how bioengineered scaffolds that are manufactured using a 3D printer may be used to stimulate tissue regeneration to help patients in the future,” Giannobile said. “Our preliminary follow-up investigations show that we will probably need to apply a more rapidly dissolving material in future human studies.”

The use of 3D printing is expected to grow rapidly in the future possibly leading to its extensive use in clinics during the next decade. Currently, 3D printing is gaining greater support in developing dental models and dental implant guides, and may be especially helpful when placing dental implants.